Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | IL |
NPI | 1003020454 |
---|---|
Provider Name | Mary Mccabe |
First Address | Morton Grove, IL 60053-2126 |
Second Address | Gurnee, IL 60031-5709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 08/07/2007 |